5 Questions: Joan Agee

Joan Agee, DNP, RN, CNOR is currently the Vice President of Patient Care Services & Chief Nursing Officer at St. Joseph Regional Medical Center in Lewiston, Idaho. She holds a Bachelor of Science in Nursing from University of Alaska, Anchorage, and a Masters in Nursing Administration from Idaho State University, Pocatello, Idaho, and a Doctor of Nursing Practice (DNP) in Healthcare Leadership from Gonzaga University in Spokane, Washington.

She has held numerous nursing leadership positions for the past 30 years. She is nationally certified as an Operating Room Nurse. She is the Idaho State Advocacy Captain for the national Chronic Obstructive Pulmonary Disease (COPD) Foundation. Her recent work on her DNP scholarly project, a Nurse-led Quality Improvement (QI) Project aimed to Reduce COPD Readmissions received the Idaho Qualis Award for innovation and success in achieving the triple aim in healthcare and improving the healthcare of people with COPD. The abstracts reporting the successful results of the COPD readmission reduction project were accepted by the American College of Healthcare Executives (ACHE) as a poster presentation at the ACHE congress in Chicago in March, 2016 and at the 2016 DNP Nurse Leadership conference at Frances Payne Bolten School of Nursing, Case Western University.

What is the biggest challenge you face in improving the lives of people with COPD?

A big challenge for people with COPD is the availability of Primary Care Providers (PCPs), both physicians and advanced nurse practitioners. This contributes to the lack of available appointment openings resulting in the person with worsening symptoms not being seen and treated in time. The domino effect is the person delays treatment or is referred to the emergency room which often results in a hospital admission. This shortage of PCPs may also impact the amount of time the PCP can spend with the patient during an office visit. Shortened times for office visits may result in: a) lack of time for the PCP to perform the spirometry test, which is necessary to diagnose COPD; b) lack of time for the PCP to find out what medications the patient can afford; and c) lack of time to teach a person and their family about the disease.

What do you think is the single most promising practice in COPD diagnosis or care right now?

I believe the single most promising practice in COPD diagnosis is spirometry. A person may have COPD but not notice symptoms until it is in the moderate stage. It is important for people to be aware of spirometry and what it is. They need to know that it is OK to ask the PCP about taking a breathing test (called spirometry) if he/she is a current or former smoker, has been exposed to harmful lung irritants for a long period of time, or has a history of COPD in his/her family.

If you had a magic wand, how would you improve COPD care?

Increase awareness of the disease in both in the public and healthcare arena which may lead to an earlier diagnosis of COPD. Here is an example of what I am referring to. I met with a woman who successfully completed six weeks of pulmonary rehabilitation classes. She explained how the classes improved her life by increasing her energy level which enabled her to better do the things she loved. She reported that she wished she had been diagnosed sooner. As it turns out, this woman had been going to her PCP for years with complaints of increasing of shortness of breath upon exertion and increasing tiredness. She was never diagnosed with COPD. Why? At every PCP visit, while sitting in the lobby waiting to see the PCP, she regained her breath and her O2 saturation improved. Also, the PCP never thought to perform spirometry. For years this woman struggled with the disease and was never taught how to slow the progression of the disease or how to better live with COPD.

Leaving symptoms misdiagnosed, untreated, or undertreated may cause them to worsen faster than if they were treated with proper medication and therapy. A person reading this may start out by taking the COPD Foundation 5-question risk screener, then talking to their doctor about spirometry.

Early screening can identify COPD before >major loss of lung function occurs.

What is one aspect of COPD diagnosis or care you think is too often overlooked?

One key aspect of care that is often overlooked is patient and family education.

Education empowers people to take care of themselves. It is important to teach people how to live life successfully with COPD; how to use inhalers; to understand methods to achieve energy-sustaining nutrition and physical exercise; and how to recognize symptoms to avoid an exacerbation (worsening of symptoms beyond the day-to-day variation).

Teach the early identification of the symptoms of COPD exacerbation such as shortness of breath, increased cough, and/or increased sputum production.

Without education, people with COPD tend to struggle on without help and end up in the emergency room and/or hospital following an exacerbation.

It is important for people to understand if they cannot afford the medication prescribed to them that they must tell the healthcare provider, because there may be other less expensive options. The worse thing a person with COPD can do is to stop taking their medication or take it less often than prescribed.

What do you think will be your most important contribution to improving the lives of people with COPD?

I believe the most important contribution to improving the lives of people with COPD is through the dissemination of information through public forums such as this, conference presentations, community awareness events, and publication.

Through the recent achievement of my Doctorate of Nursing degree, I led a quality improvement (QI) project that entailed collaborating with a regional medical center and local community partners to decrease the rate of hospital admissions and readmissions of people with COPD while maintaining quality care. Another positive outcome of the QI project was the planning and development of a pulmonary rehabilitation program. Pulmonary rehabilitation is a program of exercise, education, and support to help patients to learn to breathe—and function—at the highest level possible. The methods for the success of this COPD QI project will be published in the January, 2017 Journal of Nursing Administration (JONA).

2 Comments

I notice no mention of the important role of the Respiratory Therapist in the care and education of the COPD patient. COPD educators who are primarily RT's support all of the needs/cares that you mention. Reply